Implanting questions on the implantologist

[Anonymous]

Whatever Dr. Dilip Despande does not know about implantology can be written behind a postage stamp. Dr. Dilip Deshpande took out time from his very busy practice & patiently answered many questions on implantology. He emerged as an astute implantologist & a clinician,with a heart of a teacher, articulate as a politician but with a vision of a statesman.

How would you describe your self first: An academician or a clinician?

 To be a good academician you need to be a good clinician .An academician is complete only if he can do some research. From the time I have left NHDC I still do some research. My inputs have helped many implant companies.Every academician has to have a clinical background. To teach you need clinical experience.Academicians sometimes develop a tunnel vision & refuse to expand horizons & are unable to think laterally. I like to be an academician & I would like to be an ideal academician.

 Do you feel that there is a lot of hype around implantology in dental deliberations?

To an extent yes it is being hyped. However do remember that implantology is the final boundary in dentistry. The subject is new & not stagnated & it is like a new found treasure. Since it is one of the youngest branch of dentistry there is so much to talk about. However I consider implantology to be a routine dental procedure. 

Your comments on the current state of traning in implantology?

Dental council of India guidelines mention that implantology must be taught in periodontology, prosthetic dentistry & oral surgery departments. But not much implantology is being done. There is no dearth of patients. Not much is being done because there is fear of failure. Unless you face failure you cannot overcome failure.Dentists are scared of implantology. It is a normal subject & should be treated as such. 

Is implantology meant for Indian practice conditions?

Of course, yes. Patient awareness increasing & implantology is picking up very fast. It is the dentists who are not prepared for it. We should work more on the issues of post operative care, maintaining records. Pt. communication has to be improved. Implants maintain quality of life.

Even one implant in mandibular symphysis is successful & retains the mandibular denture. 

What kind of training should a dental surgeon take to introduce implantology in his practice?

Dentists do require through training in implantology. Not just 2 to 3 days training. Training must be by good clinicians. It must be one to one and half year course. Dentists must learn applied anatomy & physiology. In my course I made my students do dissection on cadavers.

Dentists must understand the difference in bone quality & post extraction anatomy.

In my course the first module is exclusively for anatomy & physiology. I insist on phantom work.

Institutional support is required for a thorough knowledge. Pre-conference courses are only to brush up or introduction. 

In the initial stages what would be better to refer the case or call an implantologist to your clinic?

I think it is better to refer a case than to call an implantologist to your clinic. 

Which system should a dentist start with implamtology?

Go for a system which is clinically proven. The system must have a complete range of prosthetic options. The dealer must give you prompt service. 

What could be the success rate of implantology in Indian practice condition?                    92% to 96%.Only than it is worth doing implantology. Initial period you should not have any failures. In implantology failures are only due to faulty prosthesis unless there is a gross mistake in surgery. 

Common mistakes made by dentists in implantology?

They don’t like to judge the density of bone. Even after CAT scan your personal feel is important. 

What if CAT scan facilities are not available?

Manual bone mapping.  It is simple & not expensive. That is what I did during the initial stages. 

It is necessary to take training for implantology abroad?

I would always advise clinicians to travel abroad. It opens up new vistas. Especially Germany where clinicians & technicians are exacting in their technique 

Which journal should a dental surgeons subscribe for implantology?

 Journal of Prosthetic Dentistry by the American Academy of Prosthodontics is a must read. 

Implants in posterior maxilla: Bone density is the critical point in posterior maxilla. I generally do not go beyond fist molar. After first molar there is a lot of lateral excursions. For first & second molar you can splint your implants. Maximum failure of implants is in the 2^nd molar region. There are more lateral interferences in 2^nd molar region. Generally there is reverse occlusion in 2^nd molar region. The quality of bone drastically changes in 2^nd molar region. In lower first molar there is 6% inclination. In lower 2^nd molar region there is 8% inclination.  

My first implant case!!! Any suggestions?

Implantology is one branch of dentistry where you need to plan backwards. In these days of CAT scan there is no margin for error. Know the width & length of the bone.

CAT scan is a must so you just can not go wrong. Always make a guide. Start with patients who are suffering the most i.e. patients with ill fitting dentures. This makes the patients happy. Start with mandibular symphysis area. So you get a feeling of human bone 

When should a dentist start ridge splitting?

If you have a good surgical hand you can do it. The operator must have an absolutely steady hand. 

Would you advise expanding the ridge first & than place implants or you would advise ridge split as a single step procedure?

Most of the time I always place implant immediately.Both bone plates offer primary stability to the implants. 

When should 3D models be made? 

They should be made in all multiple implant cases. 

What kind of surgical draping is required for the patient in implantology? Complete or partial?

Complete. All possible aseptic precautions must be taken. No taking chances. You need to have a trained staff 

Your favourite speakers on the international implantology lecture circuit?

Dr. Ackermann, Dr. Kirsch, Dr. Eaglehout, Dr. Joaquem Schmidt from Holland, Dr. Salama Maurice & Dr. Garber from America, Dr Arun Sethi from UK. 

Your suggestions on getting started with implant surgeries: Start with periodontal surgeries. Do not damage the gingival tissues. An implantologist has to be gentle.Single tooth implants are riskiest because & achieve right occlusion & always a challenge. Start with completely edentulous cases, then distal extension cases, then single tooth cases and then maxillary anteriors where esthetics is at a premum. 

How to fix up professional charges for implantology?

Split the charges into restorative & surgical. Costing must include failures. 

Which bone grafting material would you use?

I prefer to harvest patients own bone for bone grafting. For smaller defects I use Bio Oss. 

Implantology in diabetes & medically compromised patients?

If diabetes is under control there is no problem. I have placed implants in irradiated bone also. 

Which articulators should a clinician use?

I like simple articulators. I personally use Hanau. However there are very few technicians who can handle Hanau properly. I like Hanau- NYU series 

How can a clinician detect whether a particular lab is re-using metal?

Any dentist can make out whether recycled metal has been used. In PFM crowns of non precious alloys, if recycled metal has been used, the margins will open up during biscuit trial .Recycled metals open up much faster then virgin metal. 

Do you feel removable partial denture services are being underutilized?                              We have forgotten the basic tenets of dentistry. Basic tenets of dentistry is even stress      distribution. Valplast is flexible and therefore there is no even stress distribution. 

Many a times the dental lab does not deliver quality prostheses?

Lab always likes to cut corners. We do not have enough clinical practice in college. When we start private practice we take quite a few things for granted. There is no right knowledge imparted at UG level. We must understand that there are no magics in dentistry.

Choose the right technician & give him good impressions. Many clinicians still do not know how to make a good alginate impression. 

How much time a clinician can spend in adjusting the crown & bridges before rejecting the casting?

Your rapport with your technician is key to your successful prosthetic dentistry. Communication to lab is an art where you should be able to convey exact needs of patient.

            If you have taken good care of tooth preparation and an excellent impression there should be no reason why you should be spending more chair side time to adjust prosthesis. It just should fit without any problem.

 

There should be no need of  adjustment any prosthesis. Luting agent must not have more than 34 microns of space. 

Specific suggestions for implants prosthesis?

Implant prosthesis should be snugly fitting but passive.  It’s critical to see margins of prosthesis smoothly margins with finish line on abutment.

Your future plans?

I have now transgressed routine implantology. I now do only extreme cases or failures. I am soon buying a bone welding machine. 

Future of prosthetic dentistry & implantology?

Implantology will be practiced as a regular branch of dentistry. Prosthetic dentistry like other branches of dentistry has evolved over a period of time. Many newer restorative materials have been introduced. There will be of lot of emphasis on CAD-CAM prostheses. Zircon has a great future. 

Your comments on DENTISTRY TODAY:-It is a very commendable activity. Scientific content is very good.

        

[drsushant]

 we are indeed lucky to have a well-renowned Implantologist contribute on the site and share his views with us…gives us a good perspective…THANK YOU Dr.Dilip Deshpande

        

[drmithila]

Its a pleasure to read Dr.Dilip Deshpande s interview here on our site,,  to be able to read his views and ideas….an inspiration to us new dentists 

        

[Drsumitra]

A recent histology study from Loma Linda University demonstrated the successful osseointegration of mini dental implants after three months. This success rate is not news to those of us who have been placing mini dental implants for many years, but for practitioners looking for data regarding the long-term efficacy of mini dental implants, this recent study offers support.

Given the aging demographics of our society and the ongoing demand for dentures, general practitioners can no longer postpone adoption of this evolution in treatment. Mini dental implants provide a treatment option that is both patient-friendly and an economic boost to the dental practice.

Raymond Choi, DDS.
I have been placing 3M ESPE MDI mini dental implants for more than 12 years and have seen firsthand how they can fill a gap in a practice’s offerings, help a practice grow, and help serve patients better. Before I began offering mini implants for denture stabilization, I had been placing traditional-diameter implants for several years. While traditional implants remain the standard of care for denture stabilization and I continue to place them in my practice, the fact is that for many patients traditional implants are not an ideal treatment.

This can be due to several reasons, which vary by patient but can be divided into specific themes. First, as we know, traditional implant treatment can be very costly. For seniors living on fixed incomes, this factor alone can be enough to discourage them from traditional implants.

Second, bone levels are frequently a problem for older patients. Those who do not have adequate bone to support implants can choose to undergo bone graft treatment, but this adds expense and time to the treatment, not to mention sometimes painful recovery.

Finally, time itself is often an issue. Even patients who are able to afford traditional implants and who have adequate bone levels may not be willing to invest the time for the surgical placement of implants and the subsequent healing period.

Long-term data

For these reasons, mini dental implants provide an attractive alternative. When I meet with patients interested in denture stabilization options, I describe all the available options to them, beginning with traditional implants. I also discuss the possibilities of making new dentures, or relining existing ones, or, simplest of all, doing nothing.

But in many cases, when patients learn about mini dental implants, this is the option they find most appealing. The treatment is attractive to them because it is more affordable than traditional implants, and it also requires less bone and cases can typically be completed much faster.

Of course, it is important to discuss the available data with patients for any given treatment. In the case of mini dental implants, long-term studies are under way and 10-year data are expected soon. Currently, five- and six-year studies conducted by 3M ESPE show comparable success rates to traditional implants at 10 years. I am also able to tell patients about my personal experience performing this treatment successfully for more than 12 years.

The new histology data are summarized in 3M ESPE’s technical data sheet for MDI mini dental implants. When educating patients about the osseointegration of these devices, I often take a humorous approach, asking, "How would bone cells recognize the size of an implant when the surface material is the same?" The evidence shows they do not — and osseointegration takes place with mini implants in the same way as it does with traditional implants.

Expanding the practice

Beyond their appeal to the growing population of aging patients, mini implants should appeal to business-minded dentists as well. Very few treatments have the same potential for practice growth and can be implemented so quickly. In fact, for most dentists, it takes just one case to recoup the investment in training.

In my practice, adding this service in addition to traditional implants allowed me to treat patients who in the past would have declined traditional implants and not returned to my office. By offering an alternative, I am able to keep these patients in the practice and also grow through referrals from these very satisfied patients.

Dentists who are not currently offering any kind of implants should also take a close look at mini implants. The flapless procedure can be learned at a one-day seminar and implemented without a significant expense in new equipment.

With thousands of people turning 65 every day, and with this trend projected to continue for more than a decade, dentists must prepare themselves to cater to a new population of seniors. Implants are becoming a widely accepted treatment modality that patients are increasingly seeking out. Mini implants provide an attractive option for general dentists to respond proactively to this trend and help a large number of patients with an affordable, minimally invasive treatment.

Author disclosure: Dr. Choi is a 3M ESPE MDI mini dental implants seminar presenter.

Dr. Raymond Choi is an assistant clinical professor in the TMJ/Facial Pain Clinic at the University of Southern California and has a private general practice in Tustin, CA. He was one of the first dentists on the West Coast to place Sendax IMTEC mini dental implants for lower denture stabilization. He will be performing live patient mini implant placement and restoration and a cadaver hands-on workshop course on mini implants at the 2012 ADA Annual Session in San Francisco, October 18-20.

 

        

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